Implementing Regulations Stymie Medicaid Access and Reimbursement for Undocumented Residents Over Age 65

Beginning on January 1, 2024, New York expanded access to Medicaid coverage for nursing home residents who lack legal immigration status.

Under the new law, undocumented non-citizens in New York aged 65 and older who are otherwise eligible except for their immigration status are entitled to receive expanded Medicaid benefits, including coverage for preventive and primary care as well as nursing home benefits. However, this expanded coverage is not a cure-all, as recent regulatory guidance has made clear.

On June 10, 2024, NYCHRA’s Medical Assistance Program issued a Medicaid Alert clarifying the requirements and procedures for residents to obtain nursing home benefits under the new law. Specifically, undocumented immigrants aged 65 and older must be enrolled in a Medicaid Managed Care Plan in order to receive nursing home benefits. First, however, the resident must be found eligible to receive “emergency benefits”. Only then can he or she be transitioned and enrolled in a Medicaid Managed Care Plan. This additional step inherently creates a delay in benefits for these residents. Even if a resident is ultimately determined to be in need of “emergency benefits”, coverage in a Medicaid Managed Care Plan is not retroactive. As a result, there will always be a period of time where such a resident will not have a payment source.

Moreover, each Medicaid Managed Care Plan has a deadline by which a resident must be enrolled in order to receive benefits on the first day of the following calendar month (i.e., enroll by August 15 to receive benefits on September 1). If the necessary approval for “emergency benefits” is not received until after the deadline has expired (i.e., August 16 in the example above), the resident may be ineligible for coverage under the Plan until another month has elapsed (October 1). As such, the delays built into this process can have a very real impact on a facility’s ability to receive payment for the care provided to undocumented residents over the age of 65.

Cona Elder Law’s experienced attorneys continue to monitor the most recent developments regarding this legislation and other important legal matters concerning the nursing home industry.  Contact us at 631.390.5000 or click here to learn more about how our firm can help your facility preserve its bottom line and ensure your ability to continue to provide quality services to your nursing home residents.

Originally published in the August 2024 edition of LeadingAge NY’s Newsletter.